11 Apr 1996
Things have been rather slow here, so I thought I'd start a discussion on what people consider to be the most influential anatomic pathology textbooks they have used or use currently. To get the discussion started, I'll give my choices.
This is arguably the most verbose and lavishly illustrated editorial in the history of science, and certainly the biggest medical book to not contain a bibliography, but it represents not only the highwater mark in the writing career of one of the best classically educated and most articulate pathologists of our time, but a watershed event in the history of dermatopathopublishing. Every skin path book before this one was abysmal, while most of those published subsequent to Ackerman have been pretty decent. Ackerman's book for the first time allowed a non-dermatologist general pathologist access to the world of diagnostic pathology of the skin, beyond deciding whether or not a given lesion was a melanoma or a nevus. The monopoly of the dermatology-trained dermatopathologist was broken forever by this Promethean treatise. Finally, thanks to Ackerman's pure aesthetic demands on his editors, publishers were put on notice that tiny, muddy, fuzzy photomicrographs would no longer be tolerated (for example, just compare the illustrations of a pre-Ackermanian edition of Lever with a modern derm path text like Farmer & Hood). I think the technical excellence we see in modern pathology books can be traced directly back to Ackerman.
On the other hand, I would also voice the opinion that the book probably has misled more pathologists than all other pathology textbooks combined. It really is more an opinion piece than a rigorous academic opus, and it is quite risky to too firmly base one's pathologic diagnoses on Ackerman's naked canon. I learned this lesson the hard way, and I'll bet quite a few other neophyte pathologists did too.
Ackerman is said to have referred, perhaps jocularly, to his book as "The Bible." Actually, I think the Bible is an apt analogy, in that it also has had profound influence, but the results of that influence have not always been good.
While Ackerman's book represented a quantum leap, Page & Anderson's book built an elegant superstructure on a solid foundation laid eight years earlier by John G. Azzopardi in his Problems in Breast Pathology (WB Saunders, 1979). Page improved in Azzopardi by 1) cutting down some of the verbage and excising a lot of inconsequential trivia, 2) writing in a much tighter, more analytic style, 3) taking a more algorithmic approach in developing his nosology and developing his diagnostic approach, and 3) using higher quality illustrations and providing a greater variety of examples of problematic cases. What had previously been a cacophony of voices in breast pathology quickly congealed around Page's approach, and the mammological Tower of Babel was summarily unbuilt, expecially in regard to noncancerous atypical epithelial proliferations and the nosologic circumscription of special types of breast cancer.
The venerable, beloved "fascicles" are better than ever, with comprehensive but succinct text, abundant, high-quality illustrations (many in color), and great clinical correlation information. And for those of us who actually have to pay for our books with real money, the AFIP has a cost:benefit ratio that puts the rest of 'em to shame. God bless you, AFIP. You make me proud to be an American, even with the tax-filing deadline just four days away! :)
As The Bard observed, "A Rosai by any other name is still as sweet." "Ackerman" has always been the one to beat, and while others temporarily gain a slight edge, the next edition of Ackerman always shoves its way through the crowd, bellies up to the bar, orders a bottle of tequila and a bucket of limes, and proceeds to drink every other textbook under the table. The current edition is enormous at 2732 pages plus index. Photomicrograph quality is excellent, and many illustrations are now in color. Rosai adds nine appendices to the text proper, including information on staging, synoptic reporting, QA, and infosystems in anatomic pathology. Some of the chapters are so complete that they rival freestanding subspecialty textbooks.